Provider Demographics
NPI:1952535361
Name:GRANT, TAMISHA R (MS-CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:TAMISHA
Middle Name:R
Last Name:GRANT
Suffix:
Gender:F
Credentials:MS-CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7133 BRITENS WAY
Mailing Address - Street 2:
Mailing Address - City:BRANDYWINE
Mailing Address - State:MD
Mailing Address - Zip Code:20613-6264
Mailing Address - Country:US
Mailing Address - Phone:240-320-6356
Mailing Address - Fax:301-782-1974
Practice Address - Street 1:7133 BRITENS WAY
Practice Address - Street 2:
Practice Address - City:BRANDYWINE
Practice Address - State:MD
Practice Address - Zip Code:20613-6264
Practice Address - Country:US
Practice Address - Phone:240-320-6356
Practice Address - Fax:301-782-1974
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD662828235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist